How Often Do Long-Term Sober Alcoholics and Addicts Relapse?

Whenever a celebrity is arrested, overdoses, or dies from drugs or alcohol, there is usually renewed media interest in addiction. Most of the time, this means that experts on substance use disorders are interviewed, particularly those of us who have some experience treating high-profile addicts. The coverage usually addresses the same general principles:

Addiction is a disease, not a free choice.

Treatment, rather than incarceration, is the best choice.

Wealth and privilege tend to insulate some people from having to face the truth about their condition, but the basic principles of treatment are the same.

Treatment really works, and people do get well.

But the recent tragic overdose death of Phillip Seymour Hoffman, whom many have noted was reportedly abstinent from alcohol and drugs for over two decades, raises another set of important questions:

Do people who get sober actually stay sober?

Can’t you ever be free of addiction? Are you always at risk of relapse?

Is there some period when, like cancer, you are considered to be “cured”?

Isn’t staying sober for a long time at least somewhat protective?

In my experience treating thousands of addicts, I’ve learned that cases like these can often diminish hope and create a perception that these conditions aren’t treatable, or that addicts can never be trusted. When is an addict or alcoholic sober long enough to be considered at least relatively safe? Do most people with addiction who have been sober a long time eventually relapse? In scientific terms, what is the natural history of recovery from alcohol and drug addiction?

I’ve seen numerous experts speak up in the wake of Hoffman’s death, but few have offered hard science on what we really know about how a person’s duration of sobriety is related to their chances of being sober in the subsequent years. Fortunately, there are data to support the idea that recovery is durable, and that the vast majority of people who stay sober for a long time will continue to stay sober afterwards.

The most thorough attempt to understand what happens to addicts and alcoholics who stay sober is an eight-year study of nearly 1200 addicts. They were able to follow up on over 94% of the study participants, and they found that extended abstinence really does predict long term recovery. Some takeaways from this research are:

Only about a third of people who are abstinent less than a year will remain abstinent.

For those who achieve a year of sobriety, less than half will relapse.

If you can make it to 5 years of sobriety, your chance of relapse is less than 15 percent.

This chart illustrates these points nicely.

Extended Abstinence is Predictive of Long Term Recovery

Of course, there are many people with 10, 20, 30 or even 40 years of abstinence. What happens to these people over time? Does the relapse rate stay low, or does the relapse rate bump up later? The truth is, we simply don’t know. The number of people with long-term sobriety who are subject to this type of research is very small. There isn’t much money in studying long-term abstinent addicts and alcoholics…most of the research is focused (appropriately, I might add) on helping people achieve and maintain sobriety.

When I lectured the patients at Hazelden on addiction, I would often ask for a show of hands of people who had been sober longer than 20 years and then relapsed. Of course, this is a biased sample: patients in a residential treatment center. The lectures generally had over 200 attendees, but only 1 or 2 at most ever admitted to having such long duration sobriety in the past. My experience is that people with decades of abstinence clearly can and do relapse, but the incidence is very low. Like Hoffman and many others, it’s always heartbreaking when it happens. I’ve seen it triggered by opiate prescriptions, acute pain and other life stressors. Often the people who relapse have stopped engaging in the recovery-oriented practices that served them well during their earlier sobriety. We certainly need to learn more about what factors protect such people from relapse, and what factors predispose them to returning to addictive use.

Every death from addiction is tragic. But cases like Hoffman’s are definitely the exception and not the rule.

Hoffman is only the latest victim of a predictable as well as fabricated epidemic of heroin addiction that is spreading from coast to coast. During the Reagan administration the practice of medicine was snatched out of the hands of the M.D.s and kidnapped by MBAs. The end result is a system that invents diseases, convinces the public that they are afflicted then offers a solution for a fee. The United States represents only 3% of the World's population yet we consume 80% of the entire world supply of pain killers. In many states the Big Pharma lobbyists have authored and paid legislators to pass legislation which holds doctors liable for under-prescribing pain medication. Today, doctors are able to fill these orders on sight and are paid cryptic benefits for volume. Drug addiction is a 400 billion dollar enterprise globally and Pharmaceutical companies want their share of the addict dollar. Any addict must guard, nurture and protect his/her sobriety to any extreme. If it were up to the pharmaceutical industry every American would be consuming several substances, needed or not, from cradle to grave.

I'm 36 years clean and sober, 100% no prescriptions pot or anything else. I drank for 13 years, so I'm almost sober 3 times longer than I drank.
Drinking long ago became a non-issue for me, and I took a 12 year reprieve from meetings and AA. But I was married to a woman who was extremely helpful and we went to couples counseling for about 10 of those years, so I continued to work on myself with her help and the counselors help, and made some great progress during that period.
I am now divorced and attending meetings again, and enjoying it.
Great article, it's good to hear evidence that we stabilize with years of practice.
There are a number of variables to consider.
1)Do we work the 12 steps, I mean really work them? Not just to discuss them in meetings. In particular, steps 4,5,6,7,8,9,10? Many skimp on these steps, and pay the price. We need to continue with step 10 if we want to stay healthy.
2)Do we continue to grow along spiritual lines? Recovery IS a spiritual solution to our addictions.I've been working intensely on step 11 for the past year with really great results. We never stop growing, or we go backwards.
3)Do we depend on prescription meds for our mood swings, depression, etc.
At 10 years sober, experiencing ongoing depression, I was actually elated to read the Bill Wilson suffered depression into his 15th year sober!
I then knew I was not alone!
Addiction is not a Prozac Deficiency, or a Valium Deficiency, or whatever is the trendy drug they want to substitute nowadays.
I tend to think that the use of prescription meds can interfere with actual recovery. Just my opinion, take it or leave it.
I personally never used any anti-depressants, and I am personally skeptical of their use except as a very short term attempt to kick start someone out of a rut, then back to abstinence.
As addiction stated in his comment, we can't trust Doctors and Big Pharma with our lives, we need to use our own common sense.
Doctors today are too quick to prescribe meds to addicts.
Any prescription drug can quickly become a Gateway Drug for an addict, so we need to be our own doctors there, and be very wary of these doctors.
Just my opinion, but it's worked well for me and dozens of others I know with 2-3-4 decades of sobriety.

While you are correct that bill suffered from depression. And what now today might be labeled as bi-polar. It is in AA literature(thank god). To let doctors be doctors and that we only know a little that more will be revealed. I say this as cautionary advice because there are groups whom if you take any mind altering medication they will not sponsor nor accept you(at least in my area and yes I know this isn't inline with the traditions). So while I congratulate you for not needing psychiatric mediations, I myself am no one to judge who and who doesn't need them in recovery. I know several Schizophrenic's whom without their medications(yes I've seen them without) are dangerous not only to themselves but others. When Bill got sober it was an entirely different world(1935 remember) medically we know so much more now and will in the future. Organic mental illness is just that...Its organic(can be diagnosed differentially) and many self-medicate not knowing. I know many with long term sobriety/recovery who take medication for Bi-Polar, Severe Depression, etc etc... Who swear if they hadn't stabilized their mood they would be dead today(one way or another). I also think it is over prescribed but that's just my opinion. I as a sponsor would never suggest to someone that they weren't sober if they were taking prescribed mood stabilizing medications(anti -psychotic, anti- depressants etc...). I guess in short I don't play doctor or judge. It's also in the AA sponsorship brochure. Oddly many dont read that?

....because 12-stepping nuts like this Delray Dude have convinced people who *needed* medication for legitimate psychiatric conditions to stop taking their meds? Just his opinion? There are people that actively preach this anti-doctor and anti-medication dogma, as if people who take medications are somehow "less sober" or not sober at all. They call everything from Ativan to anti-depressants to anti-convulsants (or ANY prescription drug as Delray Dude admits) "dope" or "mind altering drugs". Good Lord, cigarettes, coffee and sugar are mind altering drugs. 12-step programs are SO dangerous with people like this with all of their anti-medical religion and "common sense". If someone in a 12-step program starts interfering with your doctors order, RUN do NOT WALK away from this person. They are valuing their religious 12-step beliefs over your health and safety. As a person who is *properly* medicated for Bipolar II I will never set foot in a 12-step room with zealots who look down their nose at me because I take a harmless anti-convulsant for my condition. Many of these people would be well-served to be on medications themselves, and some are outright psychopaths who should be locked up and not playing doctor. Telling someone to go off meds and that it's "just their opinion" is bullsh1t. These 12-step losers should NOT HAVE a MEDICAL OPINION because they are NOT DOCTORS.

I have only been in recovery for 7years from compulsive addicted gambling, and sometimes to much alcohol when I gambled. It's sad to read how "Celebrities" seem to get all the attention when they die or commit suicide from various addictions while their are many, many more who die everyday that had long recovery time and then some major life event happens and they relapse.

It's why we need to work on our recovery each and everyday to help NOT become complacent. You don't have a "Balanced Recovery" if you don't. Use a "Relapse Prevention Daily Plan" so you will be prepared, and not be caught off guard when a life event happens. We also need to remember, WE WILL ALWAYS be a bet, a drink, a pill, a needle, etc, etc, AWAY each day!
Catherine...

Excellent article; thank you! This is my 20th year of sobriety. I've used a sponsor since my first months and attend meetings every week. I have a service commitment and sponsor others. I don't talk about my major depressive disorder, but I've got it, and it has not gone away. This is between my psychiatrist and me. My meds have been as low as the smallest dosage of wellbutrin -- a year ago -- to today when I am on the highest plus one other.

Opiates (heroin, pot, oxycontin) are instantly "gratifying" mood alterers. Anti-depressants are not. They put a "floor" between me and the abyss. If you have major clinical depression, you understand the abyss. Anti-depressants keep me alive, as do therapy and practicing the principles to the best of my ability.

I am glad that not all of us in recovery have been diagnosed by a specialist as having a depressive disorder. I don't judge the appropriateness of meds for insulin-dependent diabetics, despite occasional spikes in my own blood sugar. I would hope that those with occasional episodes of depression would not judge those of us who requires meds to help manage our depressive disorders.

I'm sober 32 years and I have been out of work for almost a year now. I have found myself withdrawing, and my anxiety is also high. My sponsor never calls and I feel very alienated from people in the program, I do talk about how I feel but at the same time feel misunderstood.

I'm worried about this and hoped to get some feedback from those who relate.

You need to call your sponsor. My sponsor of 20 years never calls me. You have to chase your sobriety the way you chased a drink. Poor me, poor me, pour me a drink. Please go to meetings and let people know how you feel.

I am coming up on 5 yrs,I tend to the same also.Depression is a beast and very cunning.I drag myself out of the house some days.I make excuses for not going to meetings but I know I need to.If anything just for the socail interaction.Best wishes and congrats on 32 years.

Hey, Dude. Criticising the usage of anti-depressants is downright DANGEROUS for those suffering from depression or bipolar. I'm sober 5 years thanks to a good website, SSRI's and therapy---and most importantly, me. If I had taken the AAer advice of no drugs I would have killed myself. Consider yourself lucky that your ONLY problem was addiction. On top of my addiction I had severe depression. The depression is finally getting better (took near 5 years), but it's still there and way more difficult to manage than my alcohol addiction.

To those who find themselves with both addiction and mental illness, hang in there, and remember to get your medical advice from doctors, not fellow recovery people.

Hey, Dude. Criticising the usage of anti-depressants is downright DANGEROUS for those suffering from depression or bipolar. I'm sober 5 years thanks to a good website, SSRI's and therapy---and most importantly, me. If I had taken the AAer advice of no drugs I would have killed myself. Consider yourself lucky that your ONLY problem was addiction. On top of my addiction I had severe depression. The depression is finally getting better (took near 5 years), but it's still there and way more difficult to manage than my alcohol addiction.
To those who find themselves with both addiction and mental illness, hang in there, and remember to get your medical advice from doctors, not fellow recovery people.

Right on. Thank you to the good doctor/author. Well presented and very caring, too.

On May 17 I will achieve 25 years' continuous sobriety. I don't smoke (23 years) either. I also take lithium daily, and occasionally have to take antidepressants. I retain my addiction to Pink Floyd, strong coffee, and gardening. And so what. My cousin and my best friend have 2 and 3 years on me, respectively and neither like Roger Waters.

The most important element of a 12-step program is the 12 steps. It is not meetings, sponsors, how many days you have been hanging around the rooms (and "slipping"), your charm and popularity, or an endless stream of advice - who makes this shit up, anyway? Seriously.

AA's co-founder, Bill Wilson, saw a psychiatrist for 7 years, who became his friend. And he tried various medications, including LSD, in the interest of finding new ways of managing this disease. The Big Book of AA encourages outside solutions. Yet I and others have been publicly pilloried for managing mental illness. Ever notice how every one of these people smoke? I guess that's okay in their books.

And that is precisely my point. I submit that if you don't take care of business - spiritually, physically (exercise) financially and emotionally, along with practicing these principles in all our affairs - the story will not end well.

Back before time began, my old sponsor cautioned me that there would be an awful lot of nonsense - lies, really - in and out of AA. Usually, not always, it was to make some jackass look good and another one feel good while they preached their gospel on your time. Every third word is "I". Very tedious.

That sponsor also said that the 12 and 12 was and is the preimminent source, having been written 20 years after the Big Book. And that is why many times I would rather read than listen.

we are all entitled to our opinions, but I too battled depression for 10-15 years sober.
I remember being so relieved to read that Bill Wilson fought depression until around 15 years sober.
For those who don't know, Bill Wilson was one of the 2 founders of AA, the one who did most of the writing of the big book, and many other AA books.
Sorry, but I feel strongly that the use pf prescription drugs to alter my mood as a recovering addict is dangerous.
I have 2 close family members who traveled that road, and both ended up dead from the disease.
I felt like killing myself numerous times sober, but I'm still here, and the depression is largely a thing of the past.
I am sober over 3 decades, with no prescription or self prescribed substances at all.
So do as you will man, but I'm telling you that from my personal experience, it's a dangerous road.

I was relieved to read Bill Wilson suffered long term depression because I was thinking I was doing something wrong.
So it made it easier for me to accept that I was depressed at 8-10 years sober, or whatever it was.

I believe it is irresponsible to tell ANYONE they should NOT take antidepressant meds. Believe me, no one I know WANTS to take these medications. I have seen countless people commit suicide AND relapse over untreated depression. Most addiction professionals believe underlying depression to be a CAUSE of addiction for many addicts/alcholics trying to self medicate. The 12 steps work. Millions of us have been helped. I really wish they had better statistics on long term recovery because I see a huge deficit of long-timers in the rooms of AA--do they grow out of AA AND stay sober? Or do they relapse? We don't know because we lose them. It has become an adage that "it's a program of attraction rather than promotion" means "leave the alcoholic member alone--it's THEIR job to contact us". Bill and Bob did NOT do this and the statistics for recovery were MUCH higher in the 30s and 40s than they are now. Bill DID have depression by the way, and it almost killed him. He experimented with LSD to try to alleviate it!!! How much better his quality of life had we had SSRI's to help major depression. I agree that recovering people are most likely all depressed in their first year or so--I was--TWICE--I was told that if it persisted THEN to seek help. Too many people take meds who should not take meds, but it is a personal choice, and in my state doctors do NOT pass out meds like candy. By the way I had 7 years--relapsed--14 years--relapsed with breast cancer treatments--and 9 years--relapsed with severe depression--now I am being treated for my depression-I have chronic pain but do NOT take pain meds--they are DANGEROUS--Welbutrin is saving my life.

I have been sober from alcohol for 7 years, I have tried many anti-depressants because theu have helped me to deal with social anxiety. I would like to go through sobriety without leaning on them but in the past doing sobriety without them has been a problem.
I would like to see more about how people cope with life in long term sobriety, how they get through the various personality disorders associated with alcohol and then sobriety.
I have a website www.recoveryprincess.com where I share my sobriety story, please feel free to post your story there.
I didn't go through AA although I respect the 12 steps method, having issues with being social meant that talking in a room with tons of people didn't really work for me.

I am 3 years sober. I never attended AA or sought any other help for my former alcohol problem. In my case it was getting engaged to a non drinker that gave me the strength and motivation to quit alcohol. I didn't get any pessure from my fiance (now wife) to quit but I knew that the relationship would only work if either she started drinking or I quit. So I quit. Cold turkey. No AA, no counselling, no doctors visits. Just decided to quit and did so.

At 3 years sober it never even occurs to me to drink alcohol. My now wife and I simply don't drink. Alcohol plays no part in our lives.

Yet I also know that were I to lose my relationship with my wife I would be straight back to the bottle. No question about it. I'd be straight across the road to get some alcohol and that would be it.

I was a very heavy drinker before. I have found that sobriety is easy to maintain so long as I have my relationship with my wife. But without it I know I would relapse even if I had been sober for 30 years or more. Perhaps similar factors help explain the cases of long term sober people who relapse. There is most probably a change to their circumstances or a particular event which triggers the relapse. The alcoholism is a dark spectre that is always just over an addict's left shoulder. It can be subdued but never completely beaten. It lurks there waiting for any opportunity to pounce.

One last comment - for me it was much easier to quit alcohol completely than to ever try to moderate my intake. All or nothing. Never do anything half-hearted!

How are the authors of the study defining relapse? If I'm sober for a year then go on a binge, is that a relapse? Or is a relapse when I begin drinking on a regular basis such that it interferes with my ability to lead a normal life?

extremely well written and thoughtful from a literature standpoint but much is being left out, mainly that the great and powerful "aa" does not equate sobriety with abstinence....that being said there are millions and millions of americans who do not consume drugs or alcohol at all and would also not fulfill the great and powerful "aa's" theory of sobriety.....but again, aa will say "we are not theorizing."

Hi,
I'm sober for approximately 3 years. I didn't follow steps, I didn't go to aa. I only realized the path ahead of me if I was to continue as I was: I have kids and a good job, and the gutter is close to us all. One way to go there is with alcohol. So: I quit. Life without alcohol isn't so hard. Millions of people do that:all Muslims must. What's the big deal? Get addicted to work, family or sport or the combination, something else constructive. I assumed this was going to be for a decade... Guess from reading this article, it's for life. Well, to bad. Worse things in life than no alcohol. Millions of people have to live without food, let alone alcohol.

At 20 years sober, I had an injury and surgery and was given opiates. The high from the opiates triggered me and I chased the high for a few years, not taking the medication as prescribed. Ultimately, though I did not take a drink of alcohol, I was abusing narcotic pain medication and was not sober, Picked up a white chip at 24 years without a drink and vigilant about no narcotics or abusable medication . Getting sober the second time has been harder.